Methods and system for hemorrhage-specific determinations

ABSTRACT

Methods and a system are provided for assessing postpartum hemorrhage risk and postpartum hemorrhage stages in a clinical setting. Generally, a clinician may indicate that the mass of several bloody items, indicated in type and quantity, is to be measured using a scale. The mass of bloody items is compared to the known unused dry mass of such items in order to accurately determine the quantitative blood loss (QBL) of a patient at the bedside. The cumulative QBL can be updated by weighing additional items. Based on the cumulative QBL, the patient&#39;s vital signs, and other factors, a corresponding hemorrhage stage is identified and communicated to the clinician. Recommendations specific to the hemorrhage stage are provided to a clinician. Some recommendations are selectable actions that trigger automatic placement of medical orders and notifications to relevant medical services, such as a blood bank or anesthesia.

BACKGROUND

Emerging use of technology and devices has previously failed to addressthe difficulties of assessing a patient's risk for an occurrence ofpostpartum hemorrhage prior to labor and delivery, and accuratelydetermining a patient's quantitative blood loss during postpartumhemorrhage. More particularly, when a clinician is faced with apostpartum hemorrhage emergency, the clinician must manually estimate apatient's blood loss based on visual assessments and past experienceswith postpartum hemorrhage, in a very limited amount of time. Manualcalculation is error prone as the eyes alone cannot accurately quantifyblood loss, any visual inspection of a gynecological bleed is limited,and a bedside physical examination (i.e., using of the hands to locate)of a gynecological bleed is the most accessible way to assess thepostpartum hemorrhage before surgical intervention (e.g., in anoperating room) is needed. Because manual determination of blood loss isinaccurate, a patient's safety, care, and outcome may be negativelyimpacted. Although at least some of these problems are apparent, aneffective solution has not been proposed or implemented, as set forthhereinafter.

SUMMARY

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used as an aid in determining the scope of the claimed subjectmatter. The present invention is defined by the claims.

In brief and at a high level, this disclosure describes, among otherthings, methods, systems, and computer-readable media for makinghemorrhage-specific determinations. Generally, during a postpartumhemorrhage event, a quantitative blood loss of a patient is determinedand updated based on items exposed to the patient's blood, whetherminimally or saturated therewith. In embodiments presented herein, thequantitative blood loss is assessed based on the known dry weights oftypical or standard items used by clinicians. Based on the quantitativeblood loss, the patient's vital signs, lab results, and/or patientmedical history, a postpartum hemorrhage stage can be identified andupdated throughout the postpartum hemorrhage event. Once the postpartumhemorrhage stage is identified, recommendations are provided to aclinician and his/her medical team automatically so the clinician canquickly make treatment and intervention decisions to reduce and stop thepostpartum hemorrhage. Furthermore, clinicians can select actionablerecommendations to automatically send notifications to other medicalservices regarding the postpartum hemorrhage event as well as placemedical orders.

The claimed methods, systems, and computer-readable media of the presentapplication represent a Postpartum Hemorrhage Advisor. Not only does theclaimed invention provide clinicians recommendations for interventionduring a patient's postpartum hemorrhage event, but the Advisor providesfor modifying the patient's electronic medical record (EMR) during apostpartum hemorrhage event that is efficient, reduces human error, userfriendly, and cost-effective. Users of EMRs or electronic health records(EHR) utilizing the claimed invention will notice improved performanceof an EMR, an EMR database, and will receive recommendations for patientcare and intervention during a postpartum hemorrhage event. Furthermore,the Advisory reduces the number of “clicks” or entries a computer userhas to make in an EMR or EHR which results in reducing memoryutilization, CPU cycles, the number of operations that need to beperformed by the computer, and power consumption. The resulting costsavings and operational efficiencies of a computer EMR magnify thepotential benefits of this technology.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments are described in detail below with reference to the attacheddrawing figures, wherein:

FIG. 1 is a block diagram of an exemplary computing system suitable toimplement embodiments of the present invention;

FIG. 2 is a block diagram of an exemplary method for assessingpostpartum hemorrhage in accordance with an embodiment of the presentinvention;

FIG. 3 is a block diagram of an exemplary method for assessingpostpartum hemorrhage in accordance with an embodiment of the presentinvention;

FIG. 4 is an exemplary graphical user interface (GUI) for assessingpostpartum hemorrhage in accordance with an embodiment of the presentinvention;

FIG. 5 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 6 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 7 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 8 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 9 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 10 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 11 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 12 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention;

FIG. 13 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention; and

FIG. 14 is an exemplary GUI for assessing postpartum hemorrhage inaccordance with an embodiment of the present invention.

DETAILED DESCRIPTION

The subject matter of the present invention is described withspecificity herein to meet statutory requirements. However, thedescription itself is not intended to limit the scope of this patent.Rather, the inventors have contemplated that the claimed subject mattermight also be embodied in other ways, to include different steps orcombinations of steps similar to the ones described in this document, inconjunction with other present or future technologies. Moreover,although the terms “step” and/or “block” may be used herein to connotedifferent elements of methods employed, the terms should not beinterpreted as implying any particular order among or between varioussteps herein disclosed unless and except when the order of individualsteps is explicitly described. In the same vein, the claimed subjectmatter might also be embodied in other ways, to include differentcomponents or combinations of components, similar to those described inthis document, in conjunction with other present or future technologies.

As will be described, methods and a system for accurately assessing andtracking blood loss during hemorrhage as well as determining postpartumhemorrhage-specific stages are provided. In the clinical setting, it isdifficult for an experienced clinician to predict when a patient is atrisk for postpartum hemorrhage, to quantify actual blood loss duringhemorrhage, and assess which clinical actions to implement that areresponsive to the hemorrhage (e.g., stop or reduce blood loss) andappropriate for quantitative blood loss (e.g., a hemorrhage stage),especially when the source or location of the postpartum hemorrhage isdifficult to locate. By improving the clinician's ability to predictpostpartum hemorrhage risk in particular patients, preventative clinicalmeasures can be implemented to reduce negative outcomes for the patientand increase responsive times to actual instances of postpartumhemorrhage. For example, a hemorrhage cart may be moved to the room of apatient having increased risk of postpartum hemorrhage during labor anddelivery prior to any hemorrhage occurrence. In another example, a bloodbank may be notified in advance that a patient having a high risk forpostpartum hemorrhage has been admitted for labor and deliver and thepatient's blood type is B negative. In yet another example, specialstaff members may be called to the patient room of a patient at risk forpostpartum hemorrhage during labor and delivery, and/or a specificservice (e.g., anesthesia) may be notified to be ready or “on call” whena patient at risk for postpartum hemorrhage is admitted to the hospital.

In addition to providing advance notice of postpartum hemorrhage risk,the invention provides methods and systems that facilitate accuratemeasurements of actual blood loss and provide postpartum hemorrhagestage specific interventions for clinician evaluation in an on-goingfashion during an actual postpartum hemorrhage event. Upon a postpartumhemorrhage event occurring for a patient, for example, the clinician andmedical staff utilize a computing device and a scale device to assessand monitor the quantitative blood loss of the patient, without the needto rely on faulty and inaccurate visual estimations. During thepostpartum hemorrhage event, items may become wet with blood and/orsaturated with blood as the items are used to absorb blood, aidcoagulation, and apply pressure, for example. These used items areweighed using the scale in light of the items' previously known dryweight, so that the computing device may accurately determine apatient's quantitative blood loss. The clinicians and medical staff mayinput the type and quantity of used items into the computing deviceand/or the scale. Using the quantitative blood loss as well as otherfactors that will be discussed hereinafter, the computing devicedetermines an accurate postpartum hemorrhage stage to the clinician,regarding the patient's status.

The computing device also provides the clinician with interventions thatthe clinician may perform or orders to place that are based on thepostpartum hemorrhage stage, the patient's medical history, and otherfactors. The clinician may evaluate the patient's blood loss throughoutthe postpartum hemorrhage event and the computing device may dynamicallyprovide up-to-date quantitative blood loss information, postpartumhemorrhage stage information, and clinical intervention recommendationsbased on the quantitative blood loss information, postpartum hemorrhagestage information, and user input from a clinician and/or medical staff.

The computing device may provide interventions that are selected by userinput (e.g., touchscreen buttons) for actionable items. Exemplaryactionable items are items that prompt a user to perform a specificaction. The performance of an actionable item may be noted or logged ina single user input (e.g., one click of mouse, single gesture receivedvia a user interface, a particular keystroke or combination ofkeystrokes concurrently or in sequence) in some embodiments. Forexample, an actionable item may be displayed to a user, so that the usercan touch a touchscreen to place an order for six units of fresh frozenplasma (FFP), to place an order for two unit of platelets, to send anotification to the operating room (OR) team to prepare immediately forsurgery, to communicate a notification to the blood bank that a massiveblood transfusion is needed, to record all user input and patientmonitoring device information into an EMR of the patient, an EHR, andthe like, for example. In this way, the actionable item may beperformed. Actionable items are generally communicated to be userselectable such that selection results in the performance of an actionvia the network, computing device, and/or scale, for example. In furtherembodiments, other actionable items might foreseeably include a uservoice command received by the computing device and processed therein,wherein the voice command indicates that an actionable item (regarding arecommendation) is to be performed in response to the voice command, forexample, automatically recording all the hemorrhage event data to an EMRand/or and EHR stored at a server along with a time stamp. Anotherexemplary actionable item may include receiving a user indication toautomatically place a medical order, wherein the recommendation includesthe specific details of the medical order. In this way, the user maysimply use a mouse to click a recommendation displayed on a userinterface in order to place the medical order specified in therecommendation, for example.

It will be understood and is accepted that 1000 grams (g) are equivalentto one kilogram (kG), and 1000 milliliters (mL) are equivalent to oneliter (L). Further, it will be understood by one skilled in the art thatapproximately one mL of human blood has a corresponding mass of onegram. Therefore, 1000 mL of human blood could also be reported as 1000g, 1 kG, or one L of human blood. As used herein, the term “blood” willgenerally refer to human blood. It will also be understood that, as usedherein, blood or human blood includes platelets, proteins, red bloodcells, plasma, water, other biologic components, and/or anypharmaceutical additives as would be understood and known by thoseskilled in the art. Further, it will be understood that the abovestatement that one gram generally corresponds to one mL of blood is anapproximation, as the exact composition of blood of an individual humanpatient may be unique and slight variations are likely to existnaturally, due to medications, genetic, and/or epigenetic factors.Further, exact blood composition, and the respective weight and massthereof, may be affected by medication (e.g., anticoagulants, bloodthinners), diseases, or conditions (e.g., sickle cell disease, anemia,bone marrow disorder).

Previously, clinicians and medical staff were forced to rely on theirprevious experiences regarding hemorrhage events and visual acuity toestimate blood loss during a postpartum hemorrhage event. In the case ofpostpartum hemorrhage, blood loss may be especially difficult toaccurately assess because visual inspection of an item fails to revealexactly how much blood may or may not have been absorbed by the item.Additionally, locating the hemorrhage source is difficult and invasive,making it difficult to estimates the rate of blood loss. As will beunderstood, postpartum hemorrhage events are a true emergency and apotentially life-threatening situation that requires fast interventionand even faster decision making by the clinician and medical team.Without the ability to accurately determine a patient's blood loss, aclinician and medical team have to make intervention decisions with thelimited information available (e.g., visuals). Further, the inaccuraciesof blood loss estimation based on visuals and clinician experience arecompounded by the fact that a pregnant patient carries upwards of 10liters of blood, in comparison to a non-pregnant patient having onaverage 5 liters of blood, which may make it difficult for cliniciansand medical staff to compare a postpartum hemorrhage with otherhemorrhage experiences.

The problem of quickly and accurately assessing blood loss, trackingblood loss of a patient during acute hemorrhaging (e.g., postpartumhemorrhage) or management of blood loss in a controlled clinical setting(e.g., surgical procedures), and accessing diagnostic recommendationsspecific to the blood loss are all addressed by the present invention.

In a first embodiment, a system for assessing postpartum hemorrhage riskis provided. In embodiments, the system includes a computer server thatstores information for a plurality of patients including a firstpatient, a scale configured to measure mass of one or more items; and acomputing device in a healthcare information system. In the system, thecomputing device is communicatively coupled to the scale and isprogrammed to receive an indication from a clinician-user to measure oneor more items via the scale communicatively coupled to the computingdevice. The computing device is further programmed to referenceinformation stored on the computer server to identify whether one ormore risk factors associated with an increase in likelihood ofpostpartum hemorrhage occurrence are present in information specific tothe first patient. The computing device is programmed to measure a massof the one or more items via the scale and determine a quantitativeblood loss of a patient based on the mass of the one or more items, apredetermined dry mass of the one or more items, and when present, theone or more risk factors in the information specific to the firstpatient. In embodiments, the computing device may identify a hemorrhagestage that corresponds to the quantitative blood loss of the patient andcommunicate the hemorrhage stage and the quantitative blood loss of thepatient to the clinician-user. And, the computing device may communicateone or more recommendations to the clinician-user, wherein the one ormore recommendations are specific to the hemorrhage stage, in someembodiments. In embodiments, the hemorrhage stage and quantitative bloodloss are automatically saved to an EMR of the patient.

In another embodiment, one or more computer storage media havingcomputer-usable instructions thereon are provided. When thecomputer-usable instructions of the computer storage media are used byone or more computing devices, said instructions cause the one or morecomputing devices perform a method for postpartum hemorrhage riskassessment. In embodiments, the method is performed or executed at acomputing device coupled to a scale. The method includes receiving anindication from a clinician-user to measure one or more items via thescale and receiving an indication of a weight of the one or more itemsmeasured. Then, the method includes determining a quantitative bloodloss of a patient based on the indication of the weight of the one ormore items, in embodiments. And, a hemorrhage stage that corresponds tothe quantitative blood loss of the patient is identified. Inembodiments, the hemorrhage stage and the quantitative blood loss of thepatient are communicated to the clinician-user. The method includes, inembodiments, communicating one or more recommendations to theclinician-user wherein the recommendations are specific to thehemorrhage stage identified.

In yet another embodiment, a computerized method for postpartumhemorrhage risk assessment is provided. In embodiments, the methodincludes referencing stored patient information to identify one or morerisk factors associated with an increase in likelihood of postpartumhemorrhage occurrence. The method includes receiving an indication froma clinician-user to measure one or more items via a scale device, inembodiments. Then, a weight of the one or more items is measured and aquantitative blood loss of a patient is determined. The quantitativeblood loss of the patient is determined based on the weight of the oneor more items and a predetermined dry weight of the one or more items.The method continues by identifying a postpartum hemorrhage stage thatcorresponds to the quantitative blood loss of the patient. And, themethod includes communicating the postpartum hemorrhage stage and thequantitative blood loss of the patient to the clinician-user, andcommunicating one or more recommendations to the clinician-user, inembodiments. The one or more recommendations are specific to thepostpartum hemorrhage stage.

Referring now to the drawings in general, and initially to FIG. 1 inparticular, an exemplary computing system environment, for instance, ahealthcare information and management system, in which embodiments ofthe present invention may be implemented is illustrated and designatedgenerally as reference numeral 100. It will be understood andappreciated by those of ordinary skill in the art that the illustratedmedical information computing system environment 100 is merely anexample of one suitable computing environment and is not intended tosuggest any limitation as to the scope of use or functionality of theinvention. Neither should the healthcare information and managementsystem be interpreted as having any dependency or requirement relatingto any single component or combination of components illustratedtherein.

The present invention may be operational with numerous othergeneral-purpose or special-purpose computing system environments orconfigurations. Examples of well-known computing systems, environments,and/or configurations that may be suitable for use with the presentinvention include, by way of example only, personal computers, servercomputers, handheld or laptop devices, multiprocessor systems,microprocessor-based systems, set top boxes, programmable consumerelectronics, network PCs, minicomputers, distributed computingenvironments that include any of the above-mentioned systems or devices,and the like. In embodiments, the present invention may be implementedin computing system environments employed within healthcare facilities,such as a distributed network that communicatively couples multiple,affiliated hospitals and/or related outpatient clinics. For example,computing systems employed for healthcare facility implementation mayinclude, in addition to those examples of well-known computing systems,patient monitoring devices, scale devices, intravenous pumps, and thelike.

The present invention may be described in the general context ofcomputer-executable instructions, such as program modules, beingexecuted by a computing device. Generally, program modules include, butare not limited to, routines, programs, objects, components, and datastructures that perform particular tasks or implement particularabstract data types. The present invention may also be practiced indistributed computing environments where tasks are performed by remoteprocessing devices that are linked through a communications network. Ina distributed computing environment, program modules may be located inlocal and/or remote computer storage media including, by way of exampleonly, memory storage devices.

With continued reference to FIG. 1, the exemplary healthcare informationand management system includes a computing device in the form of acomputer server, illustrated as server 102. The server 102 may beemployed within the healthcare information and management system.Components of the server 102 may include, without limitation, aprocessing unit, internal system memory, and a suitable system bus forcoupling various system components, including a database or databasecluster. The system bus may be any of several types of bus structures,including a memory bus or memory controller, a peripheral bus, and alocal bus, using any of a variety of bus architectures. By way ofexample, and not limitation, such architectures include IndustryStandard Architecture (ISA) bus, Micro Channel Architecture (MCA) bus,Enhanced ISA (EISA) bus, Video Electronic Standards Association (VESA)local bus, and Peripheral Component Interconnect (PCI) bus, also knownas Mezzanine bus.

The server 102 typically includes, or has access to, a variety ofcomputer-readable media, for instance, a database or data store 104.Computer-readable media can be any available media that may be accessedby server 102, and includes volatile and nonvolatile media, as well asremovable and non-removable media. By way of example, and notlimitation, computer-readable media may include computer storage mediaand communication media.

Computer storage media may include, without limitation, volatile andnonvolatile media, as well as removable and non-removable media,implemented in any method or technology for storage of information, suchas computer-readable instructions, data structures, program modules, orother data. In this regard, computer storage media may include, but isnot limited to, RAM, ROM, EEPROM, flash memory or other memorytechnology, CD-ROM, digital versatile disks (DVDs) or other optical diskstorage, magnetic cassettes, magnetic tape, magnetic disk storage, orother magnetic storage device, or any other medium which can be used tostore the desired information and which may be accessed by the server102. Computer storage media does not comprise signals per se.

Communication media typically embodies computer-readable instructions,data structures, program modules, or other data in a modulated datasignal, such as a carrier wave or other transport mechanism, and mayinclude any information delivery media. As used herein, the term“modulated data signal” refers to a signal that has one or more of itsattributes set or changed in such a manner as to encode information inthe signal. By way of example, and not limitation, communication mediaincludes wired media such as a wired network or direct-wired connection,and wireless media such as acoustic, RF, infrared, and other wirelessmedia. Combinations of any of the above also may be included within thescope of computer-readable media.

The computer storage media discussed above and illustrated in FIG. 1,including a data store 104, provides storage of computer-readableinstructions, data structures, program modules, and other data for theserver 102. As such, the server 102 may be programmed to perform varioustasks using computer-readable instructions, including embodiments ofmethods described hereinafter. For example, the server 102 may beprogrammed with one or more modules that perform methods for apostpartum hemorrhage risk assessment.

In embodiments, the server 102 is coupled to a data store 104 such thatthe server 102 may access, communicate with, and otherwise retrieveinformation stored by the data store 104. In embodiments, the data store104 is a database configured to store information encoded as data. Insome embodiments, the data store 104 is configured to permanently storedata such as EMRs for a plurality of patients. In some embodiments, thedata store 104 is configured to store data regarding hemorrhage risk foreach of a plurality of patients. Additionally or alternatively, the datastore 104 may be configured to store data regarding hemorrhage risk forgroups within the plurality of patients (e.g., patient information;patient demographics such as age, race; a patient's medical history suchas the number of previous births, a multiple pregnancy (i.e., twins,triplets), a blood disorder, a medication, etc.). Exemplary hemorrhagerisk data may leverage the plurality of EMRs of patients and include oneor more of a risk grade (e.g., A, B, C, D, F), a risk level (e.g., lowrisk, medium risk, high risk), and a risk score (e.g., a numerical valuerepresenting a scale, such 1 to 5, or 1 to 100). Additionally oralternatively, the data store 104 may be configured to store dataincluding risk factors associated with an increase in likelihood ofpostpartum hemorrhage generally, or further, risk factors that areassociated with one or more specific patients, in some embodiments. Assuch, the data store 104 includes memory. In another embodiment, thedata store 104 is configured to temporarily store data, such that thedata store 104 may act, at least partially, as a cache for faster dataaccess and retrieval by the server 102. Additionally or alternatively,the data store 104 includes long-term permanent data storage for storingone or more EMRs of patients associated with a medical entity (e.g.,hospital, group of hospitals, physicians group, and an outpatientclinic). In embodiments, the data store 104 includes computer-readablemedia, as previously described hereinabove. In further embodiments, thedata store 104 may comprise a database that stores clinical interventionguidance and recommendations for hemorrhage events. In embodiments, thedata store 104 may include thresholds for triggering the communicationof each of a plurality of recommendations and/or interventions, as wellas thresholds or parameters that may be used to trigger the server 102and/or remote computing devices 108 to automatically store informationregarding the postpartum hemorrhage event, recommendations, and/orinterventions, for example, to one or more data files, a subset of datafiles, a log file, an EMR, and/or and EHR stored in the data store 104.

The server 102 may operate in a distributed network environment 106 ofthe healthcare information and management system 100. The server 102 andthe distributed network environment 106 use logical connections tocommunicate with one or more remote computers 108 and/or scale devices110. Remote computers 108 may be located at a variety of locations in amedical or research environment, for example, but not limited to,clinical laboratories, hospitals and other inpatient settings,veterinary environments, ambulatory settings, medical billing andfinancial offices, hospital administration settings, home healthcareenvironments, and clinicians' offices. Clinicians and medical staff mayinclude, but are not limited to, a treating physician or physicians;specialists such as obstetrics and gynecology (OB/GYN) physicians,surgeons, radiologists, cardiologists, and oncologists; emergencymedical technicians; physicians' assistants; nurse practitioners;nurses; nurses' aides; pharmacists; dieticians; microbiologists;laboratory experts; genetic counselors; researchers; veterinarians;students; and the like. The remote computers 108 may also be physicallylocated in non-traditional healthcare environments so that the entirehealthcare community may be capable of integration with the distributednetwork environment 106.

The remote computers 108 may include a portable computer, a laptop, atouchscreen device, a notepad, or a mobile device, in some embodiments.Exemplary remote computer 108 may include personal computers, servers,routers, network PCs, peer devices, other common network nodes, or thelike, and may include some or all of the components described above inrelation to the server 102. The devices may be personal digitalassistants or other like devices, in some embodiments.

The remote computers 108 may include, incorporate, and/or be coupled toa measurement device, such as scale device 110, for measuring weightand/or mass. Throughout this disclosure, weight and mass will be usedinterchangeably as measurement units used by methods described hereinfor quantifying blood loss. In embodiments, a scale or scale device maybe communicatively coupled to one or more of the remote computers 108 sothat the scale can measure and communicate (e.g., wirelessly ornon-wirelessly), in real-time or near real-time, weight and/or massmeasurements obtained in the clinical setting to a computing device, inembodiments. The scale may be directly coupled to one or more of theexemplary remote computers 108 or alternatively may communicate with aremote computer 108 via the network environment 106. In embodiments, acomputing device (e.g., remote computer 108) may utilize information ordata that represents measurements obtained using the scale. Thecomputing device may use the information and/or data to accurately anddynamically determine up-to-date quantitative blood loss of a patient,determine hemorrhage stage information, and/or provide clinicalintervention recommendations based on the quantitative blood lossinformation, hemorrhage stage information, and user input from aclinician and/or medical staff. In further embodiments, additionalpatient monitoring devices (not shown) may also be coupled, directly orindirectly, to the scale and computing device so as to providephysiological information that is useful to determining quantitativeblood loss, determining hemorrhage stage, and/or providing clinicalintervention recommendations. For example, patient monitoring device(s)communicate to the computing device that measurements indicate thepatient's blood pressure is dropping and pulse rate is increasing, assuch information may be used by the computing device when determiningthe hemorrhage stage and/or clinical intervention recommendations,including actionable actions.

Continuing, exemplary network environment 106 may include, withoutlimitation, local area networks (LANs) and/or wide area networks (WANs).Such networking environments are commonplace in offices, enterprise-widecomputer networks, intranets, and the Internet. When utilized in a WANnetworking environment, the server 102 may include a modem or othermeans for establishing communications over the WAN, such as theInternet. In a networked environment, program modules or portionsthereof may be stored in the server 102, in the data store 104, or onany of the remote computers 108. For example, and not by way oflimitation, various application programs may reside on the memoryassociated with any one or more of the remote computers 108. It will beappreciated by those of ordinary skill in the art that the networkconnections shown are exemplary and other means of establishing acommunications link between the computers (e.g., server 102 and remotecomputers 108) may be utilized.

In embodiments, one or more of the remote computing devices 108, and/orthe server 102, may be configured to perform methods, as describedhereinafter. For instance, a computing device and/or the server may:access a patient's EMR and/or an EHR during a postpartum hemorrhageevent; modify the patient's EMR and/or an EHR before, during, and/orafter a postpartum hemorrhage event; create new data files to be storedin a patient's EMR or in association with a patient's EMR and/or an EHR;generate a subset of data files that capture information of thepostpartum hemorrhage event including patient's vital signs, clinicianactions taken, and recommendations presented to a user; store one ormore data files to the EMR and/or an EHR, permanently and/or temporarily(e.g., to a cache); and the like. This list should not be construed aslimiting as the list illustrates merely a few of the functions performedby the components of FIG. 1. The performance of such functions may beautomatically triggered and/or manually triggered by user inputreceived, in some embodiments.

Although many other internal components of the server 102 and the remotecomputers 108 are not shown, those of ordinary skill in the art willappreciate that such components and their interconnection are wellknown. Accordingly, additional details concerning the internalconstruction of the server 102 and the remote computers 108 are notfurther disclosed herein.

Turning to FIG. 2, a flow diagram is provided illustrating a method 200for postpartum hemorrhage risk assessment, in accordance with anembodiment of the present invention. In some embodiments, the method 200may be performed using one or more computing devices including computerstorage media, such as previously described. For example, computerstorage media may have computer-usable instructions that, when used byone or more computing devices, cause said computing devices to performthe method 200. And, in embodiments, the method is performed at acomputing device coupled to a scale device, such as the exemplary remotecomputer 108 and scale device 110 illustrated in FIG. 1.

Beginning at block 202, the method 200 includes receiving an indicationfrom a clinician-user to measure one or more items via a scale device.In embodiments, the indication triggers the scale device to measure amass and/or weight of any items physically placed on the scale, forexample. For example, a medical staffer may place one patient gown, twotowels, and one “chux” pad, each holding, having captured, absorbed, orbeing saturated with, blood that the patient has hemorrhaged. Then, inthis example, the medical staffer uses a user input component to triggerthe scale device to initiate measuring the mass or weight of the patientgown, the two towels, and the one group of 5 chux pads. In furtherembodiments, the indication includes information regarding at least oneitem type, and at least one quantity of the at least one item type. Forexample, the medical staff uses a user input component to enter an itemtype (e.g., patient gown (size regular), 9×9 inch towel, and set of chuxpads) and a quantity for each item type (e.g., one patient gown, onetowel, one set of five chux pads). The entry of an item type and itemquantity may also serve as the indication that triggers the scale deviceto measure mass and/or weight of the items. Exemplary items include atowel, a wash cloth, a “chux” pad, a “laps” pad, a peripad, a blanket, adelivery kit (e.g., one blanket, 15 lap pads, and one large chux pad), adrape, a draw sheet, a gown, a warming blanket, an ice pack, and thelike. Further, exemplary items may include specific sizes, dimensions,or sets of grouped quantities (e.g., set of 5 lap pads, 15 lap pads,etc.). It will further be understood that some items are accounted forwithout physical placement on the scale. In one example, an intrauterineballoon or balloon tamponade is “weighed” or otherwise accounted forbased on user input to the scale and/or the computing device, forexample. In some embodiments, a volume of an item may be measured. Forexample, a balloon tamponade may be measured to reflect a predeterminedvolume of 500 mL, wherein a balloon tamponade is generally utilized atsaid volume. In another example, user input may be received thatindicates a balloon tamponade is measured as having a volume of 800 mL,as used in the particular hemorrhage event. Accordingly, in someinstances, items may be measured based on predetermined volume or massinformation and/or a volume may be directly input by a clinician ormedical staff (e.g., a user types the volume “800” into the computingdevice to report the usage volume of the balloon).

In another embodiment, the indication to measure one or more itemstriggers the scale device to communicate the measurement of the items toa computing device, wherein the scale device automatically measuresitems as they are placed thereon, but does not send the measurementinformation to the computing device until the indication is receivedfrom user input by the medical staff, for example. In this way, theitems are continually measured as the medical staffer places them on thescale, but the measurement information including mass or weight, itemtype, and quantity are not communicated to the computing device until auser input instructing the scale device to do so is received. It will beunderstood by those in the art that the indication received from aclinician-user to measure one or more items is not to be considered aslimiting the scale to an exact moment of initiating measurement, butrather, may trigger the scale to bundle the measurement information forcommunicating to a computing device for the purposes of determining aquantitative blood loss and/or hemorrhage stage of a patient.

Continuing to block 204, the method 200 includes receiving an indicationof a weight of the one or more items measured. As used herein, the termweight is used herein to refer to mass units (i.e., mL, L, g, kG) aswell as weight units, as is quite common in the art. Thus, albeit massand weight are differentiable scientifically, oftentimes the weight ofan object is actually described in mass units, or mass of an object isdescribed in terms of weight units, for ease.

In embodiments, the indication is provided by a scale device to acomputing device. In one embodiment, the scale is coupled to a network(e.g., hardwired or wireless, or a combination thereof) over which itcommunicates with a computing device. In another embodiment, the scaleis a separate device that is communicatively coupled to a computingdevice. And, in yet another embodiment, the scale is integrated with thecomputing device itself. The scale is physically located at or near thepatient bedside during labor and delivery, or is brought to the room ofthe patient postpartum at the onset of a hemorrhage event. In this way,the scale is easily accessible by medical staff and/or the clinician toplace used items thereon.

Generally, the indication to measure items includes one or more of thefollowing: a total weight of all the used items, a previously knownindividual dry weight for each of the used items, a predefined orpredetermined dry weight that corresponds to each of the used items, atotal dry weight that corresponds to the sum dry weight of all the useditems, an item type for each item, an item type for each of the useditems, and a quantity for each item type. In further embodiments, theindication may include additional information such as a patient'sweight, age, and the like. As used herein, “dry weight” refers to anitem in an unused state (i.e., no blood contact or absorption), removedfrom any packaging. The dry weight of items may be stored in a memory atthe computing device, or stored remotely at a server and/or in a datastore. And, the method 200 may include receiving additional indications,in some embodiments. Additional indications might include user inputthat specifies a type of blood product and quantity as administered to apatient, and/or a medication name and dosage as administered to apatient, for example.

At block 206, the method 200 includes determining a quantitative bloodloss of a patient based on the indication of the weight of the one ormore items. The quantitative blood loss is the amount of blood lost bythe patient. Generally, the quantitative blood loss is defined as theweight of the one or more used items (e.g., towels and chux padscontaining blood and blood material of the patient) measured by thescale less the dry weight(s) of each of the used items placed on thescale, in some embodiments. As previously explained, approximately onemilliliter (mL) of human blood has a corresponding mass of one gram.Therefore, each gram of difference between the known dry weight of itemsand the measured weight of the used items corresponds to 1 mL of humanblood. As will be understood, a quantitative blood loss may bedetermined based on the indication of the weight of any used items.

In further embodiments, the quantitative blood loss is determined basedon user input that indicates one or more of the following: that a bloodproduct has been administered to the patient prior to the hemorrhageevent; that a blood product has been administered to the patient duringthe hemorrhage event; that a medication or therapeutic agent thataffects or may affect blood characteristics (e.g., clotting) has beenadministered to the patient before and/or during the hemorrhage event;that a medication or therapeutic agent that affects or may affectuterine contractions has been administered to the patient before and/orduring the hemorrhage event; etc. Exemplary blood products include unitsof blood, packed red blood cells, plasma, and platelets. Exemplarymedications include oxytocin, methylergonovine (i.e., methergine),misoprostol (i.e., cytotec), 15-methyl prostaglandin (i.e., hemabate),or other pharmaceutical agents. Exemplary therapeutic agents that affectblood characteristics may include intravenous saline solution, or agentsthat increase or reduce blood volume or blood composition. The exemplaryblood products, medications, and therapeutic agents included hereinshould not be construed to be a limiting list, but rather, are exemplaryin nature and are not limiting. And further, other blood products,medications, and therapeutic agents that are not considered to have anyeffect on blood characteristics or uterine contractions may bedocumented during a hemorrhage event in order to analyze the data (e.g.,subsequently or in near real time) to identify any positive or negativecorrelations between said blood products, medications, and therapeuticagents and patient outcome.

And, at block 208, the method 200 includes identifying a hemorrhagestage that corresponds to the quantitative blood loss of the patient.Generally, a hemorrhage stage refers to a predetermined blood lossamount or a predefined blood loss amount to which a postpartumhemorrhage may be found to correspond. It will be understood that aperson having skill in the art, generally, that postpartum hemorrhagestages for a vaginal birth are different than the postpartum hemorrhagestages for a cesarean section birth. However, the exemplary guidance,ranges, amounts, and levels discussed herein are not to be construed asfinite or limiting, as it will be understood that the criteria definingeach hemorrhage stage may be subsequently modified or redefined asdetermined by agencies and organizations governing the field.

When identifying the hemorrhage stage, the method 200 utilizes thequantitative blood loss determined, one or more vital signs of thepatient, one or more lab results (if present), user input, medicalinterventions employed (e.g., administration of packed red blood cells),and other information or physiological information. For example, themethod 200 may utilize the quantitative blood loss, a patient's bloodpressure, a heart rate, hemocrit (i.e., a ratio of the volume of redblood cells to the total volume f blood), a platelet count, fibrinogen,other blood proteins, a user input specifying that oxytocin wasadministered to the patient, an indication of uterotonic usage, a userinput identifying one unit of packed red blood cells is beingadministered, and any other relevant information at or near the time ofhemorrhage assessment. As such, in some embodiments, user input may beused to inform a system determining quantitative blood loss and/or ahemorrhage stage of interventions undertaken that may affect saiddeterminations.

In identifying a postpartum hemorrhage stage for a patient having avaginal delivery, the method 200 may reference data stored (e.g.,locally or remotely) that defines hemorrhage stages specific to vaginaldeliveries. Each hemorrhage stage may include a predeterminedquantitative blood loss range. For example, regarding a postpartumhemorrhage coinciding with a vaginal delivery, a quantitative blood lossbetween 0 mL and less than or equal to 500 mL defines a Stage 0postpartum hemorrhage; a quantitative blood loss greater than 500 mL andless than or equal to 1000 mL (i.e., 1 L) defines a Stage 1 postpartumhemorrhage; a quantitative blood loss greater than 1000 mL and less thanor equal to 1500 mL defines a Stage 2 postpartum hemorrhage; and aquantitative blood loss greater than 1500 mL defines a Stage 3postpartum hemorrhage. As defined, it will be understood that thesequantitative blood loss ranges define a hemorrhage stage in the absenceof abnormal vital signs and/or the absence of irregular lab values. Itwill also be understood that a hemorrhage stage may also be defined anddetermined based on other values, ranges, or physiological factors suchas: a patient is exhibiting abnormal vital signs, oliguria, more thantwo units of packed red blood cells have been administered, a patientrequired two or more uterotonics, and the like. Generally, when apostpartum hemorrhage reaches a Stage 3 status, a massive transfusionprotocol is recommended and/or triggered in the clinical setting.

When identifying a postpartum hemorrhage stage for a patient having avaginal delivery, the method 200 may also reference data stored (e.g.,locally or remotely) that defines specific numeric values or valueranges for one or more vital signs and/or defines changes or changethresholds for one or more vital signs. Exemplary vital signs refer tomonitored measurements of a patient's heart rate, blood pressure,respiratory rate, and body temperature, for example. An intelligentlogic is employed by the method 200 to identify the hemorrhage stage,based on the quantitative blood loss, vital signs, lab results, andother factors, in various embodiments. For example, regarding apostpartum hemorrhage coinciding with a vaginal delivery, when apatient's heart rate reaches a threshold value indicative of tachycardia(e.g., greater than 110/beats per minute), the patient's respiratoryrate increases from 12 to 16 breaths per minute to 24 to 30 breaths perminute, and a quantitative blood loss of 476 mL is determined, a Stage 1postpartum hemorrhage may be identified. Thus, albeit the quantitativeblood loss indicates a Stage 0 postpartum hemorrhage, the patient'schanging vital signs are evaluated in such a way that a Stage 2postpartum hemorrhage is identified. In other words, the vital signs ofa patient as well as the quantitative blood loss influence thedetermination of the hemorrhage stage, in embodiments. For example, whena patient experiences abnormal vital signs in addition to a quantitativeblood loss that corresponds to a defined range of a lower hemorrhagestage (e.g., Stage 0), a higher hemorrhage stage may be determined(e.g., Stage 1 or Stage 2) as the abnormal vital signs qualitativelycontribute to the seriousness of the hemorrhage.

In identifying a hemorrhage stage for a patient having a cesareansection, the method 200 may reference and use stored data (e.g., locallyor remotely) that defines hemorrhage stages specific to cesareansections. For example, regarding a postpartum hemorrhage coinciding witha cesarean section, a quantitative blood loss between 0 mL and less thanor equal to 1000 mL defines a Stage 0 postpartum hemorrhage; aquantitative blood loss greater than 1000 mL defines a Stage 1postpartum hemorrhage; a quantitative blood loss up to 1500 mL defines aStage 2 postpartum hemorrhage; and a quantitative blood loss greaterthan 1500 mL defines Stage 3 postpartum hemorrhage. For example,regarding a postpartum hemorrhage coinciding with a cesarean section,when a lab result for the patient has an abnormal result (e.g., lowplatelet count), the blood pressure of the patient reached a specificchange threshold of (e.g., blood pressure has dropped by a predeterminedamount in the last few minutes), and a quantitative blood loss of 937 mLis determined, a Stage 3 postpartum hemorrhage may be identified. Inother words, the vital signs and lab results of a patient in addition tothe quantitative blood loss affect the determination of the hemorrhagestage, in embodiments.

In embodiments, the determination of a hemorrhage stage and or aquantitative blood loss may automatically trigger an action by acomputing device, a server, or the like. For example, upon determiningthat the patient has entered a Stage 1 postpartum hemorrhage, acommunication of the patient's blood type, as accessed in an EMR, may beautomatically communicated to a blood bank service (e.g., via a networkenvironment) along with one or more of the determined hemorrhage stagefor the patient, the quantitative blood loss, the patient's vital signs,and the like, all without requiring user intervention. Automaticallynotifying another medical service of relevant information reduces thenumber of user inputs or user interactions that are needed during theemergency. In another example, upon determining that a (new or updated)quantitative blood loss has been determined, all information of thehemorrhage event may be saved or stored as a data file in an EMR and/oran EHR without requiring user input or user intervention, such that acomplete record of the hemorrhage event is maintained.

Continuing, the method 200 includes communicating the hemorrhage stageand the quantitative blood loss of the patient to the clinician-user, asshown at block 210. Generally, the hemorrhage stage and the quantitativeblood loss are presented to a user on a display device, although othercommunications of this information are considered to be within the scopeof the invention. In alternative embodiments, only one of a hemorrhagestage or a quantitative blood loss of the patient is communicated to theclinician-user. In some embodiments, the hemorrhage stage and/or thequantitative blood loss are communicated to medical personnel outside ofthe patient's room. For example, the hemorrhage stage and/or thequantitative blood loss may be automatically communicated to a bloodbank, an anesthesiologist, and/or a hemorrhage team. The hemorrhagestage and/or the quantitative blood loss may be communicated to anotherremote computing device, so that the information is viewable oraccessible by another clinician, in another example. In furtherembodiments, a record or log of each and every communication is storedin a database and/or the patient's EMR.

In further embodiments, the method 200 communicates one or morerecommendations to the clinician-user. Generally, the recommendationsare specific to the postpartum hemorrhage stage that has beenidentified. Accordingly, the recommendations provided for a Stage 0postpartum hemorrhage are generally different than the recommendationsprovided for a Stage 2 postpartum hemorrhage. In embodiments, each ofthe one or more recommendations are responsive to the specifichemorrhage stage, the quantitative blood loss determined, one or morevital signs and changes thereof, a patient's medical history, and/or oneor more lab results, if present. Exemplary recommendations includedirectives and instructions for a clinician and medical staff to performspecific medical interventions, place medical orders, record informationand events during the hemorrhage, report information to other medicalstaff or another clinician, and/or to evaluate performing an action. Forexample, a recommendation may specify for a medical staff or clinicianto: “consider cause: TONE, TRAUMA, TISSUE, or THROMBIN TONE;” “performbimanual uterine massage;” “oxytocin IV increase rate;” “empty patient'sbladder;” “inspect placenta, vagina, cervix, and uterine cavity;” “callfor RN assistance;” and others. In embodiments, multiple recommendationsare provided to each of the one or more clinicians and medical staffduring a hemorrhage event.

In embodiments, each recommendation may be specific to a healthcarerole. For instance, a recommendation may be directed to a nurse rolesuch that a nurse is instructed to perform a recommended action. Inanother example, a recommendation may be directed to a physician suchthat the physician is directed to perform a recommended action. In yetanother example, a recommendation may be specifically made to a primaryregistered nurse, wherein the recommendation directs the primaryregistered nurse to perform a fundal massage. In this way, eachparticular recommendation may be directed to specific types ofclinicians or medical staff, aiding in the delegation of interventiontasks during a hemorrhage event.

In further embodiments, the recommendations may be actionable. Anactionable recommendation refers to a recommendation wherein a clinicianor medical staff may indicate whether or not the recommended action wasperformed, was not performed, is currently being performed, or will beperformed, via user input. An actionable recommendation may include anactionable item or may be communicated to a user as an actionable item,as previously described. As such, when one or more recommendations arecommunicated to a clinician, for example, the clinicians may enterinput, via the computing device, that the clinician will perform onetask and will disregard another. Based on the entered input, theclinician's indications may be saved or stored to an EMR or EHR, orfurther, displayed on a user interface with an icon or symbol thatindicates whether the user input indicated that the recommendation wasperformed, was not performed, is currently being performed, or will beperformed, as well as an identifier that is specific to the clinicianhaving entered the user input.

In further embodiments, the method 200 includes storing the hemorrhagestage and/or the quantitative blood loss of the patient. The hemorrhagestage and/or quantitative blood loss information may be storedtemporarily and/or permanently. In some embodiments, the hemorrhagestage and the quantitative blood loss information are stored permanentlyin a data store, or further, in a patient's EMR or an EHR. In someembodiments, the hemorrhage stage and the quantitative blood lossinformation are stored temporarily in a memory (e.g., RAM) at a remotecomputing device until newer or more up-to-date quantitative blood lossinformation is received. In such an embodiment, the hemorrhage stage maybe changed or updated to reflect the more recent quantitative blood lossinformation, and when such a change in hemorrhage stage occurs, themodified hemorrhage stage may be stored in a memory. In this way, themost recent information may be ‘held’ in temporary memory until orunless more up-to-date information is received via the scale, computingdevice, or user input, for example. It will be understood that temporarymemory includes RAM or cache memory, for example, and further, thatinformation stored in temporary memory may subsequently be permanentlystored in a medical record, for example, in some embodiments.Additionally or alternatively, each quantitative blood loss measured andeach hemorrhage stage determined throughout a hemorrhage event of apatient may be stored permanently to an EMR and/or an EHR. Additionalinformation (e.g., patient's vital signs, items weighed, item types,clinician notes) regarding the hemorrhage stage event may be stored onan on-going basis, in some embodiments.

Accordingly, a complete record of the events and the progression of ahemorrhage event are electronically recorded and stored.

In some embodiments, the method 200 further comprises determiningsubsequent quantitative blood loss measurements of a patient. Forinstance, after the initial quantitative blood loss is determined, thepatient may continue to bleed. Subsequently, the clinician and medicalstaff working to reduce and stop the hemorrhaging may add new items tothe scale, as they are used and become saturated with blood. As usedherein, “used items” refers to items deployed and utilized during ahemorrhage event that inadvertently capture blood, that are specificallyused to capture blood, that assist with reducing the hemorrhage, thatare used to clean up blood, and the like. The clinician and/or medicalstaff may input the type of item(s) and quantity for each type ofitem(s) that correspond to the newly used items. Therefore, when thenewly used items are added to the scale and measured, an indication of aweight of the one or more new items is received at the computing devicecoupled to the scale device. In response to receiving the subsequentindication of the weight of the new item(s), the method 200 determines asecond quantitative blood loss of the patient. Further, in such anembodiment, the method 200 may update the hemorrhage stage based on thesecond quantitative blood loss alone. Then, the method 200 communicatesthe one or more of the second quantitative blood loss and an updatedhemorrhage stage (when indicated) to the clinician and/or medical staff.

In one embodiment, the second quantitative blood loss does not includethe first quantitative blood loss. In such an embodiment, the secondquantitative blood loss is added to the first quantitative blood loss todetermine a cumulative quantitative blood loss of the patient thatreflects a total blood loss experienced by the patient since deliveryand/or hemorrhage. The cumulative quantitative blood loss may be updatedthroughout the hemorrhage event to reflect newly used items measured bythe scale device and any subsequently determined quantitative blood losscalculated therefrom. However, during the hemorrhage event, eachdistinct quantitative blood loss may also be communicated to a clinicianalong with the cumulative quantitative blood loss, so that the clinicianmay see whether the hemorrhaging rate (e.g., the amount of blood lostvia the hemorrhage over the period of time that has elapsed since aprevious quantitative blood loss was previously measured) appears to beincreasing or decreasing over time. This may aid the clinician whenmaking intervention choices and actionable items. For example, anincrease in the blood loss rate may indicate that the clinician shouldtrigger a massive transfusion protocol, transport the patient to theoperating room, and prepare or proceed with performing a laparotomy. Inanother example, a decrease in blood loss rate may indicate that thecurrent interventions are successfully stabilizing the patient.

In another embodiment, the second quantitative blood loss automaticallyincludes the first quantitative blood loss. In such an embodiment, thesecond quantitative blood loss is a cumulative quantitative amount ofblood loss that includes the patient's blood loss experienced since theonset of a hemorrhage event. With each subsequently received indicationof newly used items that are measured by the scale and/or indicated byuser input of item type and quantity, another more up-to-datequantitative blood loss may be calculated that includes each of theprevious quantitative blood losses determined during a single hemorrhageevent. For example, in a further embodiment, a third quantitative bloodloss might be calculated based on subsequently received indications ofnewly used items measured by the scale, for example. This indication isreceived after the first quantitative blood loss and the secondquantitative blood loss were calculated. In this example, the thirdquantitative blood loss automatically includes the second quantitativeblood loss, which included the first quantitative blood loss. Thus, thethird quantitative blood loss reflects the most up-to-date cumulativequantitative blood loss of the patient during the single hemorrhageevent.

With each subsequent indication of one or more newly used itemsphysically measured by the scale and described by user input of itemtype and quantity of each item type, the quantitative blood loss may bemodified to reflect the patient's overall blood loss during thehemorrhage event. Thus, the cumulative quantitative blood loss of thepatient is monitored and tracked throughout the hemorrhage event withoutthe need for any manual calculation on the part of the clinician and/ormedical staff. Similarly, the hemorrhage stage of a patient may beupdated (as needed) when a new quantitative blood loss corresponds to achange in the hemorrhage stage.

In further embodiments, the method 200 includes automatically initiatinga medical order based on the hemorrhage stage identified from thequantitative blood loss determined. For example, when a hemorrhage Stage3 is identified, an automatic medical order for a number of blood unitscorresponding to the patient's blood type may be placed to the bloodbank. The illustrative examples provided herein are not meant to belimiting, but rather illustrate the expansive capabilities of theinvention. It will be understood that a clinician evaluates theexemplary medical orders described, that the clinician controls finaldecisions in patient care, and that the clinician approves medicalorders placed during a hemorrhage event.

Continuing to FIG. 3, a flow diagram is provided illustrating a method300 for postpartum hemorrhage risk assessment, in accordance with anembodiment of the present invention. In some embodiments, the method 300may be performed using one or more computing devices including computerstorage media, such as previously described. For example, computerstorage media may have computer-usable instructions that, when used byone or more computing devices, cause said computing devices to performthe method 300. And, in embodiments, the method is performed at acomputing device coupled to a scale device, such as the exemplary remotecomputer 108 and scale device 110 illustrated in FIG. 1.

At block 302, the method 300 includes referencing stored patientinformation to identify one or more risk factors associated with anincrease in likelihood of postpartum hemorrhage occurrence. Exemplarypatient information includes information stored in an EMR such as apatient's medical history, demographic information, current medicallist, and obstetrics history. In embodiments, risk factors may bereferenced upon patient admission, intrapartum (occurring during laborand delivery), and/or postpartum.

Generally, one or more risk factors of a patient may be obtained bymedical staff or a clinician who interviews the patient directly orreviews the patient's EMR, for example. In some embodiments, postpartumhemorrhage risk factors may be obtained during routine prenatal carevisits to an obstetrics doctor's office or upon the patient's admissionfor labor and delivery. In further embodiments, risk factors, or thelack thereof, may be stored in the patient's electronic medical file,stored (e.g., permanently or temporarily, locally or remotely) in ahealthcare management system, and referred to as needed. In other words,a patient may be screened prior to a postpartum hemorrhage event toidentify risk factors that may contribute to an increased risk ofpostpartum hemorrhage. And, in yet another embodiment, risk factors maybe referenced postpartum.

Exemplary risk factors include prior uterine incision, prior cesareansection, a multiple pregnancy (i.e., twins, triplets), three or morevaginal deliveries, a known bleeding disorder, a personal history ofpostpartum hemorrhage, a family history of postpartum hemorrhage,uterine fibroids, induction of labor using oxytocin (previous deliveryand/or current labor), chorioamnionitis, estimated fetal weight greaterthan 4 kG, a body mass index greater than 35, polyhydramnios, suspectedplacenta accreta or percreta, placenta previa, known coagulopathy, ahemocrit measurement less than 30, and a platelet count less than100,000/mm³. It will be understood that these risk factors areillustrative only and should not be construed as limiting. Other riskfactors not listed herein for brevity are considered to be within thescope of the invention.

In further embodiments, when at least one risk factor is identified, themethod 300 includes using the one or more risk factors associated withan increase in likelihood of postpartum hemorrhage occurrence that areidentified to determine a postpartum risk level for the patient.Exemplary risk levels include low, medium, high, a numerical range orscale (e.g., 1 to 100, 1 to 5), a color coding system, or otherindicator that signals to a risk level to a clinician or medical staff.In embodiments where at least one risk factor is identified, the method300 may provide one or more anticipatory recommendations to a clinicianor medical staff. The anticipatory recommendation(s) may include anaction or intervention that the clinician or medical staff may performprior to the occurrence of a postpartum hemorrhage in an effort to lowerthe likelihood of occurrence of a hemorrhage, to reduce negative patientoutcomes should a postpartum hemorrhage occur, to notify appropriatepersonnel (e.g., members of a hemorrhage team, an anesthesia service, ablood bank, and operating room technicians) to be ready and prepare fora potential postpartum hemorrhage for the patient, and/or to prepare thelabor and delivery room with hemorrhage-specific supplies needed in caseof a postpartum hemorrhage, for example. In other words, an anticipatoryrecommendation is a recommendation to take an action or perform a taskprior to the postpartum phase of labor and delivery. An anticipatoryrecommendation may be preventative in nature, in embodiments.

In embodiments, anticipatory recommendations may be provided to aclinician or medical staff upon a patient's admission for labor anddelivery. As such, a medical staff member may be notified of aparticular patient's postpartum hemorrhage risk level and may receive arecommendation to transport a hemorrhage cart to the patient's room atthe onset of labor and delivery, for example. In such an example, ahemorrhage cart might include normal saline, blood tubing, rapidtransfusion tubing, 18 gauge catheters, 16 gauge catheters, lab drawequipment, blood bank bands, IV pressure bags, lap sponge packs,packing, a manual blood pressure cuff, a balloon tamponade, and a brighttask light. In another example, an anesthesia physician might receive anautomatic or manually triggered notification (e.g., phone call, text,email, and page) that a patient having a high hemorrhage risk has beenadmitted to labor and delivery, and therefore, the physician is awares/he might be called to the patient's room to administer anesthesia andprepare the patient for surgery if needed. Anticipatory recommendationsmay be specific to a person's role as a physician, surgeon, specialist,primary nurse, a registered nurse, a medical assistant, a midwife, ablood bank team member, and other roles, in further embodiments. Assuch, anticipatory actions may be undertaken on an as-needed basis priorto occurrence of a postpartum hemorrhage. Then, when a postpartumhemorrhage occurs, the method 300 may proceed with assessment of thehemorrhage as described hereinafter.

The method 300 continues with the receipt of an indication from aclinician-user to measure one or more items via a scale device, at block304. In embodiments, the indication may include a clinician or medicalstaff's interaction with the scale and/or computing device via a userinterface or user input component. For example, a clinician might use atouchscreen, keyboard, stylus, or mouse to select an option displayed ona graphical user interface, to click a button, or toggle a switch inorder to indicate that the clinician seeks to measure or weigh useditems using the scale. In another example, the indication might betriggered by the clinician beginning to position used items on thescale, to which the scale automatically detects the change in weight andbegins to weigh the items. In yet another example, a clinician might usevoice commands to interact with the computing device and/or the scalesuch that a specific vocal command is an indication to measure one ormore items. And, in another example, a medical staffer may click (e.g.,with a mouse) a symbol or icon presented on a display, wherein the clickindicates the clinician-user seeks to measure used items via the scalein order to assess a hemorrhage event using quantitative blood loss.

At block 306, the method 300 includes measuring a weight of the one ormore items. As previously described herein with reference to FIG. 2, aclinician or medical staff places one or more used items on a scale formeasuring mass or weight, as used. Some used items may be measured byvolume, in embodiments, also previously described hereinabove. Then, atblock 308, the method 300 determines a quantitative blood loss of apatient based on the weight of the one or more items, as used, and apredetermined dry weight of the one or more items.

Continuing, at block 310, the method identifies a hemorrhage stage thatcorresponds to the quantitative blood loss of the patient. As previouslyexplained with regard to the method 200 of FIG. 2, a hemorrhage stagemay be identified using quantitative blood loss, vital signs, apatient's medical history, and/or lab results, in some embodiments.Additionally, a patient's medical history and/or EMR may also bereferenced and used when identifying a hemorrhage stage. For example,the stored patient information referenced at block 302 of FIG. 3 mayfurther be used at block 310 when identifying the hemorrhage stage. Inthis way, one or more risk factors of the patient may be analyzed,weighted, or otherwise considered when the hemorrhage stage isidentified at block 310.

At block 312, the method 300 includes communicating the hemorrhage stageand the quantitative blood loss of the patient to the clinician-user. Insome embodiments, the communication is automatically provided uponidentifying the hemorrhage stage. In another embodiment, thecommunication is provided in response to a computerized indication or auser request. In some embodiments, the quantitative blood loss may becommunicated prior to the hemorrhage stage, and vice versa. In anotherembodiment, the hemorrhage stage and the quantitative blood loss of thepatient are communicated together, in real time or near real time. Thehemorrhage stage and the quantitative blood loss of the patient may bedisplayed on a user interface for the clinician-user. Finally, at block314, the method includes communicating one or more recommendations tothe clinician-user, wherein the one or more recommendations are specificto the hemorrhage stage.

FIGS. 4-14 provide GUIs of exemplary for assessing postpartum hemorrhagein accordance with an embodiment of the present invention. Inembodiments, a clinician-user or medical staff user may use the GUIs ofFIGS. 4-14 to interact with and implement the methods 200 and 300 ofFIGS. 2 and 3.

At FIG. 4, the exemplary GUI 400 provides for a “Postpartum HemorrhageAdvisor.” The GUI 400 includes an indication of a patient's risk level402, an indication of current hemorrhage stage 404, individualindicators 406, 408, and 410 for each of the patient's vital signs 405,and selectable tabs 412 and 414 that may be selected with user input totoggle a user between a Risk Assessment information and Stage andRecommendations information. The GUI 400 further includes one or moreactionable recommendations 416, organized by role, such as “PrimaryNurse” 418, “Physician” 420, and “Blood Bank” 422. In GUI 400, theactionable recommendations 416 are anticipatory recommendations and/orare specific to a Stage 0 postpartum hemorrhage. For example, ananticipatory recommendation to “Perform the appropriate anticipatoryinterventions” and “active 3^(rd) stage management” is shown as directedto the role of Physician. It will generally be understood in the artthat “3^(rd) stage” refers to the third stage of labor and deliverywherein the infant has been fully delivered through completed deliveryof the placenta.

As shown in FIG. 4, an arrow 424 corresponds to user input via a mouse,for example, wherein the user is seeking to launch or open aquantitative blood loss function of the Postpartum Hemorrhage Advisor.The user may launch this quantitative blood loss function to weigh moreused items. As shown, the patient currently has a quantitative bloodloss of 436.00 mL. By using the arrow 424 to click, hover, or otherwiseselect an illustrative “+” icon, the quantitative blood lossfunctionality may be opened, as shown in FIG. 5. Notably, the user isnot redirected to a new GUI or a new window, but rather, thequantitative blood loss functionality section 500 appears on the samescreen as a new section that visually shifts the selectable tabs 412 and414 of Risk Assessment information and Stage and Recommendationsinformation downward. The section includes a summary section 430 whereina total weight of all the used items may be displayed alongside thetotal dry weight corresponding to the item, if unused, and further, asubtotal weight may be displayed. Additionally, the summary section 430includes an area 432 for displaying an updated or new quantitative bloodloss and an area 434 for displaying a previously determined totalweight.

In the quantitative blood loss functionality section 500, severaldifferent items are presented with identifiable item types andselectable quantities for quick and easy selection by a user. The itemtypes may also be listed with mass information. Exemplary identifiableitem types with masses are presented including Towel (50 gr), Chux (25gr), Delivery Kit (150 gr), and Pad-5x (50 gr). In embodiments, one ormore open field boxes 426 and 428 are available for directly receivinguser input. For example, open field box 428 corresponds to a balloonitem for which a volume may be entered. And, open field box 426corresponds to a field for receiving direct user input of the mass orweight of the scale device. As such, a user may enter items and thequantity thereof into the quantitative blood loss functionality section500. Generally, the items entered and the corresponding quantity of eachitem type entered by the user will reflect actual used items placed on ascale for weighing.

In FIG. 5, several user indications are shown together. The illustrativearrows 424B, 424C, and 424D are meant to indicate how the user relocatesthe arrow from one location to another, in order to input information.The arrow 424B indicates the user seeks to input information regarding adelivery kit item to be weighed, the arrow 424C indicates the user seeksto input information regarding a pad-10x item to be weighed, and thearrow 424D indicates the user seeks to input information regarding alarge blue pad item, for instance.

Once entered, the item type and quantities will be displayed, as shownin FIG. 6. The used items entered by the user are shown shaded in darkgray for the purposes of this description only. Additionally, the totaldry weight that corresponds to all of the used items indicated by theuser input is displayed in the quantitative blood loss functionalitysection 500 along with the total measurement of previously entered orpreviously indicated items. In FIG. 6, a cursor 436 indicates the userhas moved the arrow to the open field box 426 in order to directly enterinformation that in this instance corresponds to the weight of thescale. In some instances, the weight of the scale is included in thequantitative blood loss assessment. The weight of the scale is includedin order to provide a complete record of all the items weighed andaccounted for, for each measurement performed. The weight of the scalecan further be used to evaluate calibration of the scale, evaluate theaccuracy of calculations, and control the quality of determinations madeusing the Postpartum Hemorrhage Advisor. After entering the weight ofthe scale, the open field box 426 reflects the weight of the scale, asentered by a user (e.g., 707.25 grams). Additionally, the quantitativeblood loss functionality section 500 now displays the scale's weightalongside the total dry weight of the used items added by user input inFIGS. 5 and 6.

In FIG. 7, the cursor 438 indicates the user has moved the arrow to theopen field box 440 in order to directly enter information regarding avolume of a suction (e.g., item type) that is in use during thehemorrhage event. In FIG. 7, at least some items are shown as measurablein volume, rather than grams. As shown in FIG. 8, the user inputindicates a volume amount that corresponds to or describes the volume ofthe suction item and that has been entered into the open field box 440corresponding to the item type “suction.” This indicates that thesuction item is in use and the user seeks to ‘weigh’ the item orotherwise account for it in determining the quantitative blood loss. InFIG. 8, the quantitative blood loss functionality section 500 displaysthe scale weight, the total dry weight of used items, a measured volume,a subtotal of the scale weight, the total dry weight of used items, andthe measured volume. Furthermore, the quantitative blood lossfunctionality section 500 displays the new quantitative blood loss basedon the scale weight, the total dry weight of used items, and themeasured volume.

Continuing to FIG. 9, the user has moved the arrow 424E to a time stampbox 444 in order to electronically time-stamp the new quantitative bloodloss of the patient. In further embodiments, the information regardingthe new quantitative blood loss is recorded to a medical file and/or thepatient's EMR. Exemplary information includes the vital signs readings,each used item type and quantities thereof, each item measured by volumeand volume quantities entered, the scale weight, the total dry weight ofthe used items, the measured volume of used items, the subtotal, theprevious total, and the like. After selecting to time-stamp the newquantitative blood loss of the patient, the user may enter comments intoa pop-up box 446, shown in FIG. 10. Comments generally include relevantinformation regarding the hemorrhage event. The information entered maythen be saved or stored in response to a received user indication, forinstance, selection of a “save” button 448 as shown with arrow 424F. Theinformation received may also be stored in an EMR and/or an EHR, as adata file, a log file, a subset of files, or the like.

At FIG. 11, the user has moved the arrow 424G to a sign button 449 inorder to electronically sign the new quantitative blood loss of thepatient. Upon selection of the sign button 449, all hemorrhage eventinformation may be electronically saved or stored, in embodiments. Forexample, the item types, the quantity of each item type, the patient'svital signs, the previously determined quantitative blood loss, the newquantitative blood loss, and other information may be saved in a datalog file or a subset of data file to the patient's EMR and/or an HER, inembodiments. And, as shown in FIG. 12, a cumulative quantitative bloodloss for this patient's particular hemorrhage event is displayed (e.g.,850.25 mL), the quantitative blood loss functionality section 500 isautomatically hidden, and the selectable tabs 412 and 414 are shiftedupwards on the screen to their original location. Additionally, thepostpartum hemorrhage has been identified as changing from Stage 0 toStage 1, such that an indication of the current hemorrhage stage 404 isdisplayed. In further embodiments, acceptance of an electronic signaturemay automatically cause one or more actionable items to be performed,such as communicating notification to a blood bank that indicates thecumulative quantitative blood loss, as updated. Such actionable itemsprovide the blood bank with notice that more packed red blood cells maybe needed, for example. As previously explained, it will be understoodthat a clinician evaluates the exemplary medical orders described, thatthe clinician controls final decisions in patient care, and that theclinician approves medical orders placed during a hemorrhage event,including actionable actions.

Turning to FIG. 12, the user has moved the arrow 424H in order to selectthe Stage and Recommendations tab 414. As shown, the currentrecommendations 416 correspond to the Risk Assessment selectable tab412, during a postpartum assessment indicated by phase box 450. It willbe understood that other boxes 452 and 454 may be selected so that auser may view recommendations that are specific to distinct phases of apatient's care for labor delivery. For example, an assessment of apatient's risk for postpartum hemorrhage may be assessed upon thepatient's admission (phase box 454) using recommendations that may beperformed at the time of admission. In another example, an assessment ofa patient's risk for postpartum hemorrhage may be assessed during orthroughout labor and delivery (phase box 452) using recommendations thatmay be performed during that time.

Upon selecting the Stage and Recommendations tab 414, relevantinformation is displayed on the GUI, as shown in FIG. 13. The Stage andRecommendation section 464 includes recommendations 462 that arerelevant to a Stage 1 postpartum hemorrhage. To the left of the Stageand Recommendation section 464 is a Stage 1 bookmark 466, which isvisually distinguishable from the other hemorrhage stages, shown asbookmarks 468, 470, and 472. Recommendations that are specific to theother hemorrhage stages, shown as bookmarks 468, 470, and 472, are notdisplayed because the patient is currently in a different postpartumstage, Stage 1. Recommendations that are specific to the otherhemorrhage stages, shown as bookmarks 468, 470, and 472, may bedisplayed if or when a corresponding or matching hemorrhage stage isidentified by the Postpartum Hemorrhage Advisor based at least on thecumulative quantitative blood loss of the patient.

In FIG. 13, the user has moved the arrow 424I in order to select aparticular recommendation, shown as “Ongoing QBL q5-15 minutes.” Uponreceiving an indication of the selection, a pop-up window 474 isdisplayed, as shown in FIG. 14. A user may input information that isrelevant to the particular recommendation “Ongoing QBL q5-15 minutes,”and save the information. As illustrated in FIG. 14, the user hasrelocated the arrow 424J in order to select a “save” button 476 andstore any entered information of the pop-up window 474 to an EMR or EHR,in embodiments. In this way, a user may track which recommendations areaddressed, not addressed, comments or reasoning for not addressing arecommendation (e.g., pop-up window 474), will be addressed, and thelike during each stage of a postpartum hemorrhage.

The recommendations may be based on the most up-to-date clinicalguidelines for postpartum hemorrhage, for example. The recommendationsmay be flanked to the left or right with a symbol or icon that signalsto a user whether that corresponding recommendation was performed, wasnot performed, is currently being performed, or will be performed.Exemplary symbols or icons include an “X,” an “O,” a checkmark, and thelike. For example, it will be generally understood that a checkmarkflanking a recommendation indicates that the recommendation has beenaddressed or otherwise performed. In another example, it will beunderstood that an “X” placed next to a recommendation indicates thatthe recommendation has not been addressed or will not be performed. Infurther embodiments, colors may be used in addition to an icon to signalto a user whether that corresponding recommendation was performed, wasnot performed, is currently being performed, or will be performed. Forinstance, the color red may be associated with a recommendation that hasnot been performed and/or will not be performed, whereas the color greenmay be associated with a recommendation that has been performed orcompleted.

The present invention has been described in relation to particularembodiments, which are intended in all respects to be illustrativerather than restrictive. Further, the present invention is not limitedto these embodiments, but variations and modifications may be madewithout departing from the scope of the present invention.

What is claimed is:
 1. One or more non-transitory computer storage mediahaving computer-usable instructions that, when used by one or morecomputing devices, cause the one or more computing devices to perform amethod for postpartum hemorrhage risk assessment, the method comprising:receiving an indication that a patient is associated with a vaginalbirth or a caesarian section birth; receiving an indication thattriggers a scale device coupled to the computing device to measure aplurality of items, the indication including an item type and a quantityfor each of the plurality of items as entered by the clinician-user viaa user input component of the computing device; measuring, via the scaledevice coupled to the computing device, a total mass of the plurality ofitems in response to the indication received; determining a total drymass of the plurality of items based on the quantity of each of theplurality items multiplied by a predefined mass of each correspondingitem type of the plurality of items as entered by the clinician-user viaa user input component of the computing device; determining, by thecomputing device, a quantitative blood loss of the patient based on acalculated difference between the total mass of the plurality of itemsmeasured by the scale device and the total dry mass of the plurality ofitems; automatically identifying, by the computing device, a hemorrhagestage that corresponds to the quantitative blood loss of the patient inview of whether the vaginal birth or the caesarian section birth isassociated with the patient; communicating the hemorrhage stage, thequantitative blood loss of the patient, and a recommendation forintervention that is specific to the hemorrhage stage to theclinician-user via the computing device; automatically initiating, bythe computing device, a medical order that is specific and responsive tothe hemorrhage stage identified, wherein when the hemorrhage stage is 3or higher, the medical order includes a quantity of blood unitscorresponding to the quantitative blood loss of the patient; andcommunicating one or more recommendations and the medical order to theclinician-user, wherein the one or more recommendations include at leastone intervention that is specific to the hemorrhage stage.
 2. The mediaof claim 1, further comprising automatically storing the quantitativeblood loss of the patient in an electronic medical record (EMR) inresponse to determining the quantitative blood loss.
 3. The media ofclaim 1, further comprising: in response to receiving a subsequentindication of a mass of one or more new items, determining a secondquantitative blood loss of the patient; updating the hemorrhage stagebased on the first quantitative blood in combination with the secondquantitative blood loss; and communicating the hemorrhage stage, asupdated, to the clinician-user.
 4. The media of claim 3, wherein thesecond quantitative blood loss includes the previously determinedquantitative blood loss and a subsequent quantitative blood lossdetermined from the subsequent indication of the mass of one or more newitems.
 5. The media of claim 1, wherein in response to identifying thehemorrhage stage that corresponds to the quantitative blood loss of thepatient, automatically storing the quantitative blood loss of thepatient in an EMR specific to the patient.
 6. The media of claim 1,wherein identifying the hemorrhage stage that corresponds to thequantitative blood loss of the patient is performed dynamically inresponse to receipt of a subsequent identification of additionalquantitative blood loss.
 7. The media of claim 1, further comprisinggenerating, by the computing device, the recommendation that is specificto a role of the clinician-user.
 8. A computerized method for postpartumhemorrhage risk assessment, the method comprising: referencing storedpatient information for a patient to identify one or more risk factorsassociated with an increase in likelihood of postpartum hemorrhageoccurrence; receiving an indication that the patient is associated withone of a vaginal birth or a caesarian section birth; receiving anindication that triggers a scale device coupled to the computing deviceto measure a plurality of items, the indication including an item typeand a quantity for each of the plurality of items as entered by theclinician-user via a user input component of the computing device;measuring, via the scale device coupled to the computing device, a totalmass of the plurality of items in response to the indication received;determining an aggregated predefined mass of the plurality of itemsbased on the quantity of each of the plurality items multiplied by apredefined mass of each corresponding item type of the plurality ofitems as entered by the clinician-user via a user input component of thecomputing device; determining a quantitative blood loss of the patientbased on a calculated difference between the total mass of the pluralityof items measured by the scale device and the aggregated predefined massof the plurality of items; automatically identifying a postpartumhemorrhage stage that corresponds to the determined quantitative bloodloss of the patient in view of whether the vaginal birth or thecaesarian section birth is associated with the patient and the one ormore risk factors associated with the increase in likelihood ofpostpartum hemorrhage occurrence; communicating the postpartumhemorrhage stage the determined quantitative blood loss of the patient,and a recommendation for intervention that is specific to the hemorrhagestage to the clinician-user via the computing device; automaticallyinitiating, by the computing device, a medical order that is specificand responsive to the postpartum hemorrhage stage, wherein when thehemorrhage stage is 3 or higher, the medical order includes a quantityof blood units corresponding to the quantitative blood loss of thepatient; and communicating one or more recommendations and the medicalorder to the clinician-user, wherein the one or more recommendationsinclude at least one intervention that is specific to the postpartumhemorrhage stage.
 9. The method of claim 8, further comprising: uponidentifying the one or more risk factors associated with an increasedlikelihood of postpartum hemorrhage occurrence that are present in thestored patient information, calculating a value that represents apostpartum hemorrhage risk that is specific to the patient and that isbased on the one or more risk factors identified.
 10. The method ofclaim 8, further comprising: generating the one or more recommendations,wherein the one or more recommendations are specific to a role of theclinician-user.
 11. The method of claim 8, wherein the intervention isan actionable recommendation.
 12. The method of claim 11, furthercomprising: in response to a user input selecting the actionablerecommendation, automatically performing the actionable recommendationvia the computing device, wherein performance of the actionablerecommendation includes one or more of communicating a notification ofthe postpartum hemorrhage to a medical service, or recording the currentvital signs of the patient, the quantitative blood loss, and thepostpartum hemorrhage stage to an EMR.
 13. The method of claim 8,further comprising: when the postpartum hemorrhage stage identified isstage two postpartum hemorrhage, automatically communicating anindication of the stage two postpartum hemorrhage to one or more of anobstetrician, an anesthesiologist, and a blood bank team member.
 14. Themethod of claim 8, further comprising: in response to measuring a massof one or more additional items via the scale device, determining asecond quantitative blood loss of the patient based on the mass of theone or more additional items and a predetermined dry mass of the one ormore additional items; determining a cumulative quantitative blood lossof the patient that includes the determined quantitative blood loss andthe second quantitative blood loss; identifying a second postpartumhemorrhage stage that corresponds to the cumulative quantitative bloodloss of the patient; and when the second postpartum hemorrhage stagethat corresponds to the cumulative quantitative blood loss of thepatient is different than the postpartum hemorrhage stage previouslyidentified, communicating the second postpartum hemorrhage stage to theclinician-user.
 15. The method of claim 14, further comprising:communicating one or more updated recommendations to the clinician-user,wherein the one or more updated recommendations are specific to thesecond postpartum hemorrhage stage.
 16. The method of claim 8, whereinidentifying the postpartum hemorrhage stage that corresponds to thequantitative blood loss of the patient further comprises evaluatingcurrent vital signs of the patient for abnormalities and evaluating theone or more risk factors identified.
 17. A system for assessingpostpartum hemorrhage risk, the system comprising: a computer serverthat stores at least an EMR of first patient; a display deviceconfigured to display a graphical user interface; a scale deviceconfigured to measure mass of items; and a computing device in ahealthcare information system, wherein the computing device iscommunicatively coupled to the scale device and the display device, andwherein the computing device is programmed to: cause display of thegraphical user interface via the display device; receive an indicationfrom a clinician-user to measure the items that are used for the firstpatient, via the scale device, wherein the indication specifies an itemtype and a quantity of the item type entered by the clinician-user viathe graphical user interface for each of the items; measure the totalmass of the items that are used for the first patient, via the scaledevice, in response to the indication received; reference the EMR of thefirst patient stored on the computer server to identify whether a riskfactor associated with an increased likelihood of postpartum hemorrhageoccurrence is present; receive an indication that the first patient isassociated with one of a vaginal birth or a caesarian section birth;determine a quantitative blood loss of the first patient based on: thetotal mass of the items measured, and a total predetermined mass of theitems based on, for each of the items, the item type and the quantity ofthe item type as entered by the clinician-user via the graphical userinterface; identify a hemorrhage stage that corresponds to thequantitative blood loss of the patient in view of whether the vaginalbirth or the caesarian section birth is associated with the firstpatient and, when present, the risk factor in the EMR of the firstpatient; automatically store the hemorrhage stage and the quantitativeblood loss to the EMR of the first patient at the computer server;automatically initiate, by the computing device, a medical order that isspecific and responsive to the hemorrhage stage, wherein when thehemorrhage stage is 3 or greater, the medical order includes a quantityof blood units corresponding to the quantitative blood loss; causedisplay of the hemorrhage stage, the quantitative blood loss, one ormore recommendations and the medical order to the clinician-user via thegraphical user interface, wherein the one or more recommendationsinclude at least one intervention that is specific to the hemorrhagestage.